Use of Biocidal Surfaces for Reduction of Healthcare Acquired Infections

218 Pages·2014·3.45 MB·English

by  Gadi Borkow (eds.)

Gadi Borkow Editor
Use of Biocidal
Surfaces for Reduction
of Healthcare Acquired
Infections
Use of Biocidal Surfaces for Reduction
of Healthcare Acquired Infections

Gadi Borkow
Editor
Use of Biocidal Surfaces
for Reduction of Healthcare
Acquired Infections
Editor
GadiBorkow
CupronInc.
Herzelia,Israel
ISBN978-3-319-08056-7 ISBN978-3-319-08057-4(eBook)
DOI10.1007/978-3-319-08057-4
SpringerChamHeidelbergNewYorkDordrechtLondon
LibraryofCongressControlNumber:2014946414
©SpringerInternationalPublishingSwitzerland2014
Thisworkissubjecttocopyright.AllrightsarereservedbythePublisher,whetherthewholeorpart
of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations,
recitation,broadcasting,reproductiononmicrofilmsorinanyotherphysicalway,andtransmissionor
informationstorageandretrieval,electronicadaptation,computersoftware,orbysimilarordissimilar
methodologynowknownorhereafterdeveloped.Exemptedfromthislegalreservationarebriefexcerpts
inconnectionwithreviewsorscholarlyanalysisormaterialsuppliedspecificallyforthepurposeofbeing
enteredandexecutedonacomputersystem,forexclusiveusebythepurchaserofthework.Duplication
ofthispublicationorpartsthereofispermittedonlyundertheprovisionsoftheCopyrightLawofthe
Publisher’s location, in its current version, and permission for use must always be obtained from
Springer.PermissionsforusemaybeobtainedthroughRightsLinkattheCopyrightClearanceCenter.
ViolationsareliabletoprosecutionundertherespectiveCopyrightLaw.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publicationdoesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesareexempt
fromtherelevantprotectivelawsandregulationsandthereforefreeforgeneraluse.
While the advice and information in this book are believed to be true and accurate at the date of
publication,neithertheauthorsnortheeditorsnorthepublishercanacceptanylegalresponsibilityfor
anyerrorsoromissionsthatmaybemade.Thepublishermakesnowarranty,expressorimplied,with
respecttothematerialcontainedherein.
Printedonacid-freepaper
SpringerispartofSpringerScience+BusinessMedia(www.springer.com)
Contents
1 Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
GadiBorkow
2 SurvivalofMicroorganismsonInanimateSurfaces. . . . . . . . . . . . . 7
AxelKramerandOjanAssadian
3 TheRoleofContaminatedSurfacesintheTransmission
ofNosocomialPathogens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
JonathanA.Otter,SaberYezli,andGaryL.French
4 RoleoftheMicrobialBurdenintheAcquisitionandControl
ofHealthcareAssociatedInfections:TheUtilityofSolidCopper
Surfaces. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
MichaelG.Schmidt,AndreaL.Banks,andCassandraD.Salgado
5 BiocidalHardandSoftSurfacesContainingCopperOxide
ParticlesfortheReductionofHealthcare-AcquiredPathogens. . . . 85
GadiBorkow
6 BiocidalMechanismsofMetallicCopperSurfaces. . . . . . . . . . . . . . 103
ChristopheEsp´ıritoSanto,NadezhdaGerman,JuttaElguindi,
GregorGrass,andChristopherRensing
7 AnOverviewoftheOptionsforAntimicrobialHardSurfaces
inHospitals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
JonathanA.Otter
8 EconomicsofUsingBiocidalSurfaces. . . .. . . . . . .. . . . . .. . . . . .. 167
PanosA.Efstathiou
9 AlternativeRoomDisinfectionModalities–ProsandCons. . . . . . . 187
GeorgeByrns
Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
v
Chapter 1
Preface
GadiBorkow
Contents
References......................................................................................... 4
Healthcare-acquired infections (HAI) have become a very significant medical
concernbothindevelopedandindevelopingcountries,especiallyasmicroorgan-
isms have developed high resistance to the existent antibiotics arsenal. While no
exactnumbersexist,itisassessedthatmillionsofpeopleworldwideacquireaHAI
each year. These infections contribute significantly to morbidity, mortality and
hospitalization costs. For example, in the United States alone, it was estimated
that ~2 million HAI occur each year by all types of microorganisms, causing or
contributing to ~100,000 deaths and adding ~$10 billion in additional healthcare
expensesannually[1–3].
InordertoreduceHAIrates,themedicalcommunityhasdevelopedaggressive
measures – such as use of disposable equipment, healthcare staff education for
improved hygiene, increased number of nurses and infection control personnel,
isolationofinfectedpatients,betterventilationmanagement,useofhigh-efficiency
particulate air filters, improved disinfection regimens, and use of aggressive anti-
biotic control programs. Indeed, all these measures have resulted in significantly
lowerHAIrates;however,eveninhospitalswheretheseinfectioncontrolmeasures
arerigorouslyimplemented,theHAIratesarestillunacceptablyhigh,anditisclear
that the current modalities to eliminate HAIs are not sufficient. The risk of an
individual to acquire an infection while in the hospital is still intolerable and
additionalwaystofightHAIneedtobedeveloped(Fig.1.1).
There is increasing evidence that potentially overlooked and neglected sources
of nosocomial pathogens that significantly contribute to HAI are contaminated
non-intrusive soft and hard surfaces located in the clinical surroundings, and that
G.Borkow,Ph.D.(*)
CupronInc.,Hasadnaot10,46733Herzelia,Israel
e-mail:[email protected]
G.Borkow(ed.),UseofBiocidalSurfacesforReductionofHealthcare 1
AcquiredInfections,DOI10.1007/978-3-319-08057-4_1,
©SpringerInternationalPublishingSwitzerland2014
2 G.Borkow
Current Rigorously Implemented Measures to Reduce HAI Rates
(cid:129) Hand washing before and after every contact with a patient or
object
HAI (cid:129) Isolation of infected patients
Rates (cid:129) Use disposable and personal protective equipment
(cid:129) Use of HEPA filters and better ventilation management
(cid:129) Improved disinfection regimens
(cid:129) Improved hospital cleaning
(cid:129) Increased personnel per patient
(cid:129) Increase in infection control personnel
(cid:129) Aggressive antibiotic control programs
Overlooked and neglected -
bio-control of the inanimate
environment
Years
Fig.1.1 HAIarenoteliminatedbythecurrentimplementedmeasures
thereisaclearcorrelationbetweentheenvironmentalbioburdenpresentinaclinical
setting and the risk of patient of acquiring an infection [4–14]. Thus using self-
disinfectingsurfacescanbeaveryimportantadjunctinthefightagainstHAI[15,16].
Copperisanessentialtraceelementneededforthenormalfunctionofallaerobic
lifeforms.Itsabilitytocyclebetweentwooxidationstates,Cu1+andCu2+,iskey
to a wide array of metalloenzymes that catalyze electron transfer reactions.
Conversely,coppercanbehighlytoxicdueinparttoitsabilitytogeneratereactive
oxygen species. Thus microorganisms have developed a complex series of mech-
anismstoregulatecopperintracellularaccumulationanddistribution[17,18].How-
ever, above a certain threshold of exposure to copper, which varies between
microorganisms, the microorganisms are killed, sometimes within minutes
(e.g.[19–21]),viadifferentmultisiteparallelmechanisms[22].
TheancientGreeksinthetimeofHippocrates(400BC)werethefirsttodiscover
thesanitizingpowerofcopper.Theyprescribedcopperforpulmonarydiseasesand
for purifying drinking water. Since then copper has been used as a biocide for
treatingsoresandskindiseasesandforpurifyingwaterbymanycivilizations,such
as the Celts, Phoenicians, Egyptians, Hindus, and Aztecs [23]. By the eighteenth
century copper had come into wide clinical use in the Western world for the
treatment of mental disorders and afflictions of the lungs. Furthermore, in the
eighteenth century it was discovered that no fungi grew on seed grains soaked in
coppersulphate.Beginningintheearly1950s[e.g.[24–26]],thebiocidalproperties
of copper and copper compounds were demonstrated in controlled laboratory
studies. Notably, copper surfaces or copper compounds have been shown to be
efficaciousagainsthard-to-killspores[27–33].
Todaycopperbiocideshavebecomeindispensableandmanythousandsoftons
areusedannuallyallovertheworldfor(i)preventionofroofmossformation[34];
1 Preface 3
(ii) wood preservation [35]; (iii) control of green slime in farm ponds, rice fields,
irrigation and drainage canals, rivers, lakes and swimming pools [36];
(iv)preventionofdownymildewongrapes[37];and(v)antifoulingpaints[38–40].
Non-soluble copper compounds, such as degradable phosphate glass fibres
impregnated with CuO [41, 42], glass coated with thin films of CuO [43], or
metallic and copper alloys [20, 32, 44–50] also exert potent biocidal properties,
including against hard-to-kill spores [27–33]. Importantly, in March 2008 the
U.S. Environmental Protection Agency (EPA) has approved the registration of
copperalloysasmaterialswithantimicrobialproperties,thusallowingtheCopper
DevelopmentAssociation(CDA)tomakepublichealthclaims[51].Morerecently,
Cupron Inc. received similar approvals by the EPA to make public health claims
withitscopperoxideinfusedcountertops.Thesepublichealthclaimsacknowledge
that alloys containing above 60 % copper and surfaces impregnated with 16 %
copper oxide particlesare capable ofkilling more than 99.9 % of harmful, poten-
tially deadly bacteria, such as Methicillin-resistant S. aureus (MRSA) within 2 h,
andcontinuetokillmorethan99%ofbacteriaevenafterrepeatedcontamination.
CopperistheonlymetalthathasreceivedthistypeofEPAregistrations.
This book discusses the role of the environment as a potential source for out-
breaksofHAIandfocusesontheutilityofsolidcoppersurfacesandcopperoxide
impregnated materials in reducing bioburden and fighting HAI. It also reviews
otherbiocidalsurfacealternativesandtheeconomicsofusingbiocidalsurfacesina
hospitalenvironment.Finally,itdiscussestheprosandconsofexistentdisinfection
modalitiesotherthanbiocidalsurfaces.
More specifically, in Chap. 2 of this book, Axel Kramer and Ojan Assadian,
discuss the ability of pathogenic bacteria, fungi and viruses to persist and survive
for long-term periods on inanimate surfaces. They discuss the factors influencing
the survival of these pathogens in the environment and the mechanisms by which
pathogensaretransmittedfromtheseinanimatesurfacestosusceptiblepatients.
InChap.3,JonOtter,SaberYezliandGaryL.Frenchprovideproofthatsurface
contaminationbynosocomialpathogensshedbypatientscontributestonosocomial
cross-transmission and HAI. They review evidence that improved environmental
hygiene can help bring HAI rates down and consider various options to address
contaminatedsurfacesinhealthcarefacilities.
In Chap. 4, Michael G. Schmidt, Andrea L. Banks, and Cassandra D. Salgado,
furtherdiscusstheeffectofenvironmentalcontaminationandHAIandreviewthe
studies showing the use of biocidal metallic copper surfaces resulting in dramatic
reductionofbioburdenandimportantlyofHAIrates.
In Chap. 5, I discuss how regular hospital linens, uniforms and other hospital
textilesare aneglected sourceofnosocomialpathogens andhow self-disinfecting
biocidaltextilescansignificantlycontributetothereductionofHAI.SpecificallyI
review the studies showing that incorporation of copper oxide in hospital textiles
can reduce bioburden and HAI rates. I also briefly review the novel successful
endowment of biocidal properties to non-porous solid surfaces by impregnating
themwithcopperoxideparticles.
4 G.Borkow
InChap.6,ChristopheEsp´ıritoSanto,NadezhdaGerman,JuttaElguindi,Gregor
Grass,andChristopherRensing,discusswhyontheonehandcopperisanessential
element to microorganisms and how copper homeostasis is achieved, and on the
other hand how copper exerts its potent biocidal properties, with special focus on
the molecular mechanisms underlying bactericidal properties of solid copper
surfaces.
InChap.7,JonOtterreviewspotentialandexistentbiocidalsurfacealternatives
to copper. He discusses what should be the ideal biocidal surface candidate and
discusses the pros and cons of each of the existent candidate alternatives, the
optimal deployment modes, the surfaces that should be made self-disinfecting
surfaces,andhowdowetestandcompareefficacyofantimicrobialsurfaces.
InChap.8,PanosA.Efstathiouevaluatestheimpactofusingbiocidalsurfaces
in a hospital environment, specifically discussing the use of metallic copper sur-
faces in the intensive care units, reaching the conclusion that the use of biocidal
surfaceshassignificantpositiveeconomicadvantages.
Finally,inChap.9,GeorgeByrnsreviewstheprosandconsofusingchemical
fumigationandgermicidalUVCirradiationinhealthcareandotherrelatedsettings.
HeraisestheconcernthatwhilebothfumigationandUVirradiationarecapableof
killing microorganisms, it is uncertain whether the benefits in terms of overall
hospital patient infection rates outweigh the risks and costs associated with these
methods, further strengthening the importance of using biocidal self-disinfecting
surfacestocombatenvironmentalcontamination.
Ihopethisbookwillgivesignificantsupporttothenotionthattheinclusionin
clinicalsettingsofself-disinfectingbiocidalhardandsoftsurfacescansignificantly
helpinthefightagainsthealthcare-acquiredinfections.Ialsohopeyouwillfindthis
bookinformative,comprehensiveandinteresting.
References
1.Klevens RM et al (2007) Estimating health care-associated infections and deaths in
U.S.hospitals,2002.PublicHealthRep122(2):160–166
2.ReedD,KemmerlySA(2009)Infectioncontrolandprevention:areviewofhospital-acquired
infectionsandtheeconomicimplications.OchsnerJ9(1):27–31
3.Zimlichman E et al (2013) Health care-associated infections: a meta-analysis of costs and
financialimpactontheUShealthcaresystem.JAMAInternMed173(22):2039–2046
4.BhallaAetal(2004)Acquisitionofnosocomialpathogensonhandsaftercontactwithenviron-
mentalsurfacesnearhospitalizedpatients.InfectControlHospEpidemiol25(2):164–167
5.BoyceJM,Potter-BynoeG,ChenevertC,KingT(1997)Environmentalcontaminationdueto
methicillin-resistant Staphylococcus aureus: possible infection control implications. Infect
ControlHospEpidemiol18(9):622–627
6.EcksteinBCetal(2007)ReductionofClostridiumDifficileandvancomycin-resistantEntero-
coccus contamination of environmental surfaces after an intervention to improve cleaning
methods.BMCInfectDis7:61